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Methodology of measuring postoperative cognitive dysfunction: a systematic review.

Friedrich Borchers1, Claudia D Spies1, Insa Feinkohl2

  • 1Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.

British Journal of Anaesthesia
|April 6, 2021
PubMed
Summary

Methodological inconsistencies in diagnosing postoperative cognitive dysfunction (POCD) hinder research. Standardizing cognitive testing and reporting is crucial for future studies on POCD.

Keywords:
diagnostic criteriamethodologyneurocognitive disordersneuropsychological testingperioperative cognitionpostoperative cognitive dysfunction

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Area of Science:

  • Anesthesiology and Perioperative Medicine
  • Neuroscience
  • Medical Methodology

Background:

  • Postoperative cognitive dysfunction (POCD) is a significant adverse outcome affecting patient quality of life.
  • Current diagnosis relies on pre- and post-operative cognitive testing, but methodological heterogeneity limits study comparability and meta-analysis.
  • A systematic review is needed to appraise POCD study methodologies since the 1995 Consensus Statement.

Purpose of the Study:

  • To critically appraise the methodology of studies investigating POCD published between 1995 and 2019.
  • To provide recommendations for future authors to improve the quality and comparability of POCD research.

Main Methods:

  • Systematic literature review of studies published from 1995 to 2019.
  • Inclusion criteria: baseline cognitive testing, structured cognitive test battery, and a minimum 1-month follow-up.
  • Data from primary publications were supplemented with later follow-up studies for cohorts with multiple publications.

Main Results:

  • A total of 274 unique studies were analyzed, utilizing 259 different cognitive tests.
  • Significant variations observed in timing of assessment, follow-up duration, definition of POCD, and use of control groups.
  • Pooled incidence of POCD was 29.0% (2998/10335 patients) in studies reporting it as a dichotomous outcome at 1 to <3 months.

Conclusions:

  • Overwhelming heterogeneity in POCD study methodologies exists since the 1995 Consensus Statement.
  • Future research quality and comparability can be enhanced by optimizing assessment timing.
  • Adopting commonly used cognitive tests, including the Consensus Statement 'core battery,' and improving reporting standards are recommended.